Enough, Really

I hate to say that I became jaded with the ER over the course of the month, but I really did. Maybe it was the lady who came in with allergic conjunctivitis. Her eyes had been kind of itchy for three days, no vision changes, no pain. She was using visine and it seemed to help. Not quite an emergency and nothing we can really do. Next. Or maybe it was the guy I saw at 2 am a few days ago who said his car had been side swiped and his right hand crushed because he had been sticking it out the window. He had wrist drop, radial nerve injury findings, and a little swelling, but the hand didn't look that hurt. The mystery deepened when X-rays didn't show any fractures or dislocations or anything. It took an orthopedics consult going back and grilling him twice for him to admit that he just fell asleep in his car with his arm out the window and when he woke up he couldn't use his wrist. Classic case of Saturday Night Palsy. I felt a little bad I didn't pick up on it earlier, but when a patient is blatantly lying to you, what are you going to do? I think the last straw was the woman who came in with bruising on her hand and said she had dropped a cabinet on it. I was super sympathetic, she had a definite injury, but then my attending was like, "oh, I know that lady". Apparently she was a frequent customer and judging from her INSPECT report she got several prescriptions for narcotics from different ERs around the area every month for back strain, neck strain, bruising, etc. etc. Sigh. I just want to go back to peds where I can deal with pushy parents and not worry about patients seeking drugs at least until they are teenagers.

Of course, there were some interesting patients too. The schizophrenic patient who said a demon named "Terry" had taken his finger and twisted it around three times. Sure enough, he had a spiral fracture of his third digit. He was off his meds so I think the world will never know whether he did it to himself, someone else assaulted him, or it really was "Terry". I also had a really sweet, old, confused lady with metastatic lung cancer and a giant plural effusion making it hard for her to breathe. I got to do a thoracentesis and drain all the fluid off her lung which was fun for me and a big help to her. Score. Then there was the other sad patient who had a 75 pound unintentional weight loss over the past 7 months. Totally emaciated, easy bruising, feeling horrible, and he just didn't want to go to the doctor. I had to leave before I got to see his lab results, but I think he most likely has cancer till proven otherwise. Really nice guy, and really sad. That's another thing I like about peds...I feel like even the most negligent parents would bring their kid in to a doctor well before they lost a third of their body weight. Please, if you have sudden weight loss for no apparent reason, go see your doctor!

I think this video says it best. Goodbye ER. Good short term experience. Not for me.